Search PubMed⌕ Search

Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

At least 343 records · Page 19Linked to original sources
PubMed1990

Changing concepts in the management of retinoblastoma.

For many years the most common treatment for retinoblastoma has been enucleation, generally performed on the affected eye in children with unilateral sporadic disease and on the more severely affected eye in children with bilateral disease. With refinements in conservative treatment methods, however, the affected eye now often may be salvaged and useful vision retained. Emphasizing this trend, we present our current approaches to managing retinoblastoma based on our experience with 324 patients, outlining our indications and pointing out a number of misconceptions about the role of enucleation, photocoagulation, cryotherapy, and radiotherapy in treating this condition. We also sketch some recent findings regarding the genetics of retinoblastoma and consider ways in which such research may lead to improved management of the disease.

Brachytherapy↗
PubMed1990

Squamous cell carcinoma of the conjunctiva associated with benign mucous membrane pemphigoid.

A 67-year-old white man with benign mucous membrane pemphigoid OU developed, over a period of two months, a slightly pedunculated fleshy mass in the bulbar conjunctiva OS. The mass was excised and found histopathologically to be squamous cell carcinoma of the conjunctiva. The association of benign mucous membrane pemphigoid and squamous cell carcinoma of the conjunctiva has not been previously reported in the English literature to our knowledge. The significance of the simultaneous occurrence of these two conditions is discussed.

Aged↗
PubMed1990

Postsurgical hematic cyst simulating a conjunctival melanoma.

A 75-year-old man had undergone bilateral intracapsular cataract extraction and then a scleral buckling procedure for an aphakic retinal detachment in the right eye. He presented 15 years later with a dark brown mass in the superior fornix of his right eye. On the basis of the clinical findings, the diagnosis of a conjunctival melanoma was considered. The lesion was surgically excised and found to be a chronic hematic cyst that arose adjacent to a episcleral sponge placed at the time of retinal detachment surgery. Hematic cysts should be included in the differential diagnosis of pigmented conjunctival lesions.

Aged↗
PubMed1989

The role of cryotherapy in the management of retinoblastoma.

Between February 1974 and August 1987, we treated 67 retinoblastomas in 47 eyes of 45 patients with cryotherapy (triple freeze-thaw technique). Overall, cryotherapy eradicated 53 (79%) of the tumors, whereas additional treatment with episcleral plaque radiotherapy, external beam radiotherapy, or enucleation was necessary in 14 (21%) of the tumors. Tumor destruction was achieved with one or more cryotherapy treatments in all cases in which the tumor was no greater than 2.5 mm in diameter and 1.0 mm in thickness, and in which the tumor was confined to the sensory retina without seeding into the adjacent vitreous humor. We therefore recommend cryotherapy in such cases. Cryotherapy alone failed in 14 larger tumors, ten of which had clinical evidence of vitreous seeding by tumor cells. Cryotherapy is therefore contraindicated in cases of vitreous seeding or if the tumor exceeds 3.5 mm in diameter and 2.0 mm in thickness. Cryotherapy can be successful for tumors up to 3.5 mm in diameter and 2.0 mm in thickness, but more than one treatment may be necessary.

Combined Modality Therapy↗
PubMed1989

Decreasing frequency of enucleation in patients with retinoblastoma.

We reviewed our 15-year experience with the management of 324 cases of retinoblastoma. There has been a definite trend away from enucleation in both unilateral and bilateral cases during recent years. In cases of unilateral retinoblastoma, the affected eye was salvaged in 4% of cases (two of 49) during the five-year interval from 1974 through 1978, in 14% of cases (seven of 50) from 1979 through 1983, and in 25% of cases (20 of 80) from 1984 through 1988. In cases of bilateral retinoblastoma, both affected eyes were salvaged in 4% of cases (one of 24) from 1974 through 1978, in 18% of cases (nine of 50) from 1979 through 1983, and in 25% of cases (18 of 71) from 1984 through 1988. Earlier diagnosis of retinoblastoma and refinements in conservative methods of management are believed to be the main reasons for this trend away from enucleation.

Child↗
PubMed1989

Pseudo-Schnabel's cavernous degeneration of the optic nerve secondary to intraocular silicone oil.

A 29-year-old man sustained severe trauma to his left eye requiring corneoscleral wound repair and retinal detachment repair. Because of a persistent retinal detachment, he underwent vitrectomy and silicone oil implantation into the vitreous cavity. Over the ensuing 2 years 4 months, the eye gradually became glaucomatous, blind, and painful, requiring enucleation. Histopathologic examination revealed that coalescent globules of silicone oil had infiltrated the entire length of the attached atrophic optic nerve. Superficially reminiscent of the changes seen in Schnabel's cavernous optic atrophy, this observation provides evidence for the theory of Zimmerman et al concerning the pathogenesis of cavernous degeneration of the optic nerve in glaucomatous eyes.

Adult↗
PubMed1989

Mesectodermal leiomyoma of the ciliary body managed by partial lamellar iridocyclochoroidectomy.

In the right eye of an 11-year-old girl, a large iridociliochoroidal mass developed that measured approximately 14 x 12 x 9 mm in size. The tumor initially resembled a uveal melanoma on the basis of clinical appearance and ancillary studies. Enucleation was not done, however, because of the patient's age and the unusual transillumination properties of the lesion. Instead the tumor was resected by a partial lamellar iridocyclochoroidectomy with an excellent visual outcome. Light and electron microscopy and immunohistochemistry established that the tumor was a leiomyoma. A literature review showed that all but one of the 15 previously reported cases of ciliary body leiomyoma that the authors were able to verify were found in women with an average age of 30 years. The possible significance of this apparent age and sex predilection for this unusual tumor is discussed, and the clinical features which may help differentiate leiomyoma from uveal melanoma are presented.

Age Factors↗
PubMed1989

Reasons for enucleation after plaque radiotherapy for posterior uveal melanoma. Clinical findings.

A review of 1019 patients with posterior uveal melanomas who were treated with episcleral plaque radiotherapy showed that 59 (6%) required enucleation of the affected eye. Seventeen of the enucleations were done within 1 year, 30 within 2 years, and 55 within 5 years. The enucleated eyes had been treated with a cobalt-60 plaque in 39 cases, a ruthenium-106 plaque in 13 cases, an iodine-125 plaque in four cases, and an iridium-192 plaque in three cases. The primary reasons for enucleation included tumor regrowth in 30 cases (51%), neovascular glaucoma in 18 (31%), patient request in five (8%), scleral melting in four (7%), painful bullous keratopathy in one (2%), and hemolytic glaucoma in one (2%). The time interval from plaque treatment to eventual enucleation averaged 29 months. Tumor regrowth requiring enucleation was detected clinically an average of 28 months after treatment. In these cases the average radiation dose to the tumor apex was 7700 cGy and to the tumor base 36,000 cGy. Uncontrollable neovascular glaucoma occurred an average of 38 months after plaque radiotherapy and, most commonly, after cobalt-60 plaques were used. Eyes with plaque-induced scleral melting eventually required enucleation after an average of 10 months. In all cases of scleral melting, the tumor was ciliochoroidal.

Adult↗
PubMed1989

Episcleral plaque radiotherapy for retinoblastoma.

The authors report their preliminary results of episcleral plaque radiotherapy (cobalt 60, iridium 192, ruthenium 106, and iodine 125 plaques) in 50 selected patients with retinoblastoma. There were 97 plaque applications to 51 affected eyes in these 50 patients. The plaque was used as primary treatment in 15 eyes and as secondary treatment after failure of external beam radiotherapy, photocoagulation, and/or cryotherapy in 36 eyes. Vitreous seeding of tumor cells was evident ophthalmoscopically in 49 of the 51 eyes, negating the possibility of ultimate success by further photocoagulation or cryotherapy. In 18 patients, the contralateral eye had been enucleated and the remaining eye was being considered for enucleation because all other treatment modalities had failed. In 2 of these 18 patients (11%), the remaining eye was salvaged with plaque radiotherapy and some vision was preserved. In 33 eyes with less advanced tumors, 31 had some degree of vitreous seeding by tumor cells. The eye has been retained in all 33 of these patients and useful vision preserved in most. On the basis of these preliminary observations, the authors conclude that plaque radiotherapy can be used successfully as a primary treatment for selected cases of unilateral or bilateral retinoblastoma or as a supplemental treatment after other treatment methods have failed. The current indications for plaque radiotherapy and its advantages over other therapeutic modalities are discussed.

Brachytherapy↗
PubMed1989

Clinicopathologic review of 142 cases of lacrimal gland lesions.

A review of 142 lacrimal gland biopsies performed during a 25-year period at a major eye hospital showed that 78% of lacrimal gland lesions were of nonepithelial origin and only 22% were primary epithelial neoplasms. The nonepithelial lesions included inflammation (64%) and lymphoid tumors (14%), whereas the epithelial lesions included dacryops (6%), pleomorphic adenoma (12%), and malignant epithelial tumors (4%). These results contradict the much quoted dictum that 50% of lacrimal gland lesions are primary epithelial tumors and 50% are nonepithelial lesions.

Adenocarcinoma↗
PubMed1989

Immunohistochemistry of retinoblastoma. A review.

Various studies which relate to the immunohistochemical identification of neuronal, glial, carbohydrate and nucleic acid associated antigens in retinoblastoma will be reviewed. The majority of these studies appear to support the concept that retinoblastomas arise, in situ, from neuron committed cells and in some cases specifically into photoreceptor-like cells. In selected cases, however, glial cell differentiation may be a feature of the tumor. In addition, the molecular biology of the retinoblastoma gene and the immunohistochemical characterization of its gene product will be discussed.

Antibodies, Monoclonal↗
PubMed1989

Current treatment of retinoblastoma.

Based on personal experience with 324 children with retinoblastoma who were managed on the Ocular Oncology Service at Wills Eye Hospital between 1974 and 1988, the authors review their current management of this tumor, emphasize common misconceptions in management, and describe the recent research related to the genetics of retinoblastoma. It is pointed out that the optic nerve should not be clamped at the time of enucleation. Photocoagulation should only be used to treat small tumors strictly confined to the retina and it is contraindicated if there is vitreal or choroidal invasion. The tumor should not be directly photocoagulated but rather surrounded by photocoagulation to destroy its blood supply. Cryotherapy should generally be applied to small peripheral tumors and should not be attempted if there is evidence of vitreous seeding of the tumor. External beam irradiation should employ an anterior as well as a lateral portal. Carefully selected radioactive plaque therapy, when it can be used, has distinct advantages over external beam radiotherapy.

Eye Neoplasms↗
PubMed1988

Natural course of melanocytic tumors of the iris.

The authors received the charts and photographs of 175 patients who had suspicious melanocytic lesions of the iris and who were followed without treatment. Only eight (4.6%) of these lesions showed clinical evidence of enlargement during follow-up intervals of 1 to 12 years (mean, 4.7 years). Features that were associated with enlargement of the lesion included medial location of the mass on the iris and presence of pigment dispersion onto the adjacent iris and anterior chamber angle structures. Features that were unassociated with growth of the lesion included patient age and sex, intraocular pressure, iris color, tumor size and vascularity, and presence of pupillary distortion, ectropion iridis, and sector cataract. From these results, recommendations are made which can assist the ophthalmologist in the management of pigmented iris lesions.

Adult↗
PubMed1988

Sebaceous carcinoma of the glands of Zeis.

A 64-year-old woman developed a slowly enlarging yellow mass in the left upper eyelid that was removed by wedge resection. Histopathologic examination revealed the tumor to be a sebaceous adenocarcinoma of the glands of Zeis. The clinical features, histopathology, management, and prognosis for Zeis gland carcinomas are discussed, with emphasis upon their differences from the more common Meibomian gland carcinomas.

Adenocarcinoma↗